La Porta E. MD; Faragli A. MD
Contamination from COVID-19 leads to an overt infection in about half of cases, with a wide range of signs and symptoms, from a mild flu-like illness to severe, potentially lethal pneumonia. However, as far as we presently know, re-infection is possible, contamination can occur in the pre-symptomatic stage and the disease can be even transmitted by non-symptomatic carriers .
Modern health care systems seem unprepared to manage this pandemic crisis. The healthcare industry is structured on the historically necessary model of in-person interactions between patients and their clinicians . In the last decade, many hospitals have reorganized and “industrialized” outpatient care, building large open spaces, where multiple specialists will furnish hundreds, or perhaps even thousands of consultations per day . Clinical workflows and economic incentives have been largely developed to support and reinforce a face-to-face model of care, resulting in the congregation of patients in emergency departments and waiting for areas during this crisis .
The history of SARS-CoV-2 has shown us that in this attempt to “rationalize” our activities, we have forgotten about infectious diseases. This care structure contributes to the spread of the virus to uninfected patients who are seeking evaluation. Vulnerable populations such as patients with heart failure or kidney disease will face the difficult choice between risking iatrogenic COVID-19 exposure during a clinician visit and postponing needed care . In medicine, a common indication is to limit hospital access to patients with severe clinical problems, for those who, require regular hospital treatment. Urgent action is required to transform healthcare delivery and to scale up our systems by unleashing the power of digital technologies .
For this reason, we are now assisting at a turning point in history in which telemedicine is developing from a “nice-to-have” to a “must-have” technology . Remote patient monitoring, in facts, represents at this moment the only way to follow-up chronic patients at high risk of mortality such as heart failure, diabetic, hypertensive and kidney disease patients, just to mention some of them . Digital technologies, such as those used for telemedicine, have existed for decades; they have had poor penetration into the market because of heavy regulation and sparse supportive payment structures . However, the need for a remote patient monitoring to prevent mortality and unwanted hospitalizations has always been there [5,6].
By considering, for instance, heart failure and kidney disease patients, they represent two groups of patients at extremely high risk of adverse events and worst outcome in case of COVID-19 infection . They are chronic, old, and fragile and present multiple comorbidities. Heart failure and kidney disease not only coexist in more than 60% of the cases, but they share the same clinical manifestation: a chronic condition of body fluids congestion . Body fluids congestion represents the cause of hospital admissions in 90% of cases in these patients and represents also the main cause of worsening of patients’ health status, leading to a concatenation of re-hospitalizations events and a high mortality risk . While the management of body fluids in these patients is complex in hospital settings, it becomes even more difficult in-home settings. Patients are left with standard weight scales that have been proven to poorly detect decompensation events in time, delaying a potential diagnosis of almost a week on average [8-10]. Invasive solutions such as cardioMEMS, even if proven to be effective, are generally limited to a small group of patients that fulfill specific criteria .
Thanks to the artificial intelligence technology, BOCAhealth role is to give to the medical doctor a risk assessment and a prediction of future decompensation events. This allows the medical doctor to be assisted in a decision such as therapy optimization or whether hospitalizing a patient whose conditions are worsening.
During the COVID-19 pandemic, all telemedical solution becomes extremely relevant, and especially BOCAhealth can assume a relevant role in those patients that suffer from body fluids disorders, such as heart failure and kidney disease. If these patients get infected with COVID-19, their mortality risk increases suddenly. They do not just need to stay at home, they need to be constantly monitored to prevent acute hospitalizations.
Telemedicine is essential during the COVID-19 crisis and after it [2,3]. This sentence is now clear to the global medical and scientific community and BOCAhealth is ready to provide the best medical support that chronic patients with problems of fluid balance deserve.
1. Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, Liu L, Shan H, Lei C-l, Hui DSC, Du B, Li L-j, Zeng G, Yuen K-Y, Chen R-c, Tang C-l, Wang T, Chen P-y, Xiang J, Li S-y, Wang J-l, Liang Z-j, Peng Y-x, Wei L, Liu Y, Hu Y-h, Peng P, Wang J-m, Liu J-y, Chen Z, Li G, Zheng Z-j, Qiu S- q, Luo J, Ye C-j, Zhu S-y, Zhong N-s (2020) Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine. DOI:10.1056/NEJMoa2002032
2. Keesara S, Jonas A, Schulman K (2020) COVID-19 and Health Care’s Digital Revolution. New England Journal of Medicine. DOI:10.1056/NEJMp2005835
3. Piccoli GB (2020) Hospitals as health factories and the coronavirus epidemic. Journal of Nephrology 33 (2):189-191. DOI:10.1007/s40620-020-00719-y
4. Schulman KA, Richman BD (2019) Toward an Effective Innovation Agenda. New England Journal of Medicine 380 (10):900-901. DOI:10.1056/NEJMp1812460
5. Sterling R, LeRouge C (2019) On-Demand Telemedicine as a Disruptive Health Technology: Qualitative Study Exploring Emerging Business Models and Strategies Among Early Adopter Organizations in the United States. J Med Internet Res 21 (11):e14304-e14304. DOI:10.2196/14304
6. Dorsey ER, Topol EJ (2016) State of Telehealth. New England Journal of Medicine 375 (2):154- 161. DOI:10.1056/NEJMra1601705
7. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R (2008) Cardiorenal Syndrome. Journal of the American College of Cardiology 52 (19):1527-1539. doi:https://doi.org/10.1016/j.jacc.2008.07.051
8. Ishikawa S-E (2015) Hyponatremia Associated with Heart Failure: Pathological Role of Vasopressin-Dependent Impaired Water Excretion. Journal of clinical medicine 4 (5):933-947. DOI:10.3390/jcm4050933
9. Ong MK, Romano PS, Edgington S, Aronow HU, Auerbach AD, Black JT, De Marco T, Escarce JJ, Evangelista LS, Hanna B, Ganiats TG, Greenberg BH, Greenfield S, Kaplan SH, Kimchi A, Liu H, Lombardo D, Mangione CM, Sadeghi B, Sadeghi B, Sarrafzadeh M, Tong K, Fonarow GC, Better Effectiveness After Transition–Heart Failure Research G (2016) Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure: The Better Effectiveness After Transition -- Heart Failure (BEAT-HF) Randomized Clinical Trial. JAMA Intern Med 176 (3):310-318. DOI:10.1001/jamainternmed.2015.7712
10. Abraham WT, Compton S, Haas G, Foreman B, Canby RC, Fishel R, McRae S, Toledo GB, Sarkar S, Hettrick DA, Investigators ObotFS (2011) Intrathoracic Impedance vs Daily Weight Monitoring for Predicting Worsening Heart Failure Events: Results of the Fluid Accumulation Status Trial (FAST). 17 (2):51-55. DOI:10.1111/j.1751-7133.2011.00220.x
11. Abraham WT, Perl L (2017) Implantable Hemodynamic Monitoring for Heart Failure Patients. Journal of the American College of Cardiology 70 (3):389-398. doi:https://doi.org/10.1016/j.jacc.2017.05.052